CONSUMER AUTHORIZATION FOR DIRECT PAYMENT VIA ACH (ACH DEBITS)I authorize SeaCoast Financial, LLC, hereinafter called “Company,” to initiate debit entries to my account indicated below and the Financial Institution named below, hereinafter called “Financial Institution,” to debit the same account. I acknowledge that the origination of ACH transactions to my account must comply with U.S., South Carolina law and NACHA Rules. Your Name(Required) First Last Your Address(Required) Street Address Address Line 2 City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your Phone(Required)Your Email Address(Required) CONSUMER AUTHORIZATION FOR DIRECT PAYMENT VIA ACH (ACH DEBITS)Direct Payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment. By signing this authorization, I (we) agree to the following terms:Authorization(Required)I (we) authorize SeaCoast Financial, LLC (“COMPANY”) to electronically debit my (our) account (and, if necessary, electronically credit my (our) account to correct erroneous debits) as follows: Checking Account Savings Account Bank Name(Required)Routing Number(Required)Only 9 DigitsAccount Number(Required)Revocation of Authorization This authorization will remain in full force and effect until I (we) notify SeaCoast Financial, LLC of my (our) intent to revoke it. Revocation must be provided: In writing: SeaCoast Financial, LLC - 103 Regency Commons Dr., Unit E, Greer, SC 29650-5210 By phone: (864) 874-6100 Revocation must be received at least three (3) business days prior to the scheduled transaction date to allow reasonable time for processing.This is a recurring payment authorization, and I (we) have the right to receive a copy of this authorization upon request. Debits will be processed as authorized above unless revoked. Any erroneous or unauthorized debits will be addressed in compliance with NACHA rules and South Carolina law. I AGREE THAT: This is a recurring payment authorization, and I (we) have the right to receive a copy of this authorization upon request. Debits will be processed as authorized above unless revoked. Any erroneous or unauthorized debits will be addressed in compliance with NACHA rules and South Carolina law.SignatureDate(Required) MM slash DD slash YYYY UploadMax. file size: 128 MB.Upload a copy of a voided check or proof of account ownershipThis field is hidden when viewing the formUnique ID
